Self-Care in High Stress Environments

This is a guest post from Dr Naomi Johnstone, who is currently working in Afghanistan for Norwegian Refugee Council. 

We all know that getting enough sleep, eating well and exercising regularly are important for our wellbeing – albeit not particularly easy to do in this industry. Beyond these basics, during my present posting in Afghanistan I’ve tried to develop a few other healthy habits, or ‘active coping strategies’.

• Taking regular time off. I take off a day every week, and when possible, a few evenings as well. I use the time to do things that help me disconnect from work, and connect with other parts of myself. Within the restrictions of Afghanistan life, for me this includes practising yoga, designing, cooking with or for people, reading a book, hanging out in a garden with friends, stargazing from the rooftop, skyping friends, or watching a movie. There’s nothing weak or lazy about taking this time.

• Practising mindfulness/connecting spiritually. I have a ‘toolbox’ of various meditative and spiritual practises I’ve used regularly in the past and choose at least one to practise every day or so. These help to keep me connected and be present. I often do this during my commute or field travel in the morning to start the day off, and/or before bed to wind down.

• Keeping in touch with supportive people. Most weeks I Skype at least three family members and good friends, and take regular time out of Afghanistan to reconnect with them in person. WhatsApp has also been a great easy, but private, way to connect through daily photos, videos and quick messages. Research shows that having strong social support networks is one of the most important factors for building resilience amongst national and international humanitarians. This is also true for relationships related to the workplace, so efforts to build team cohesion and social support at work are very valuable.

• Laughing often. At myself, at my colleagues (not in a mean way!), at absurdities of the work or culture clashes. I regularly watch or read something that makes me laugh. Appreciate people you can laugh with and encourage others not to take themselves too seriously.

• Establishing a prior relationship with a counsellor/psychotherapist. I check in via Skype with mine every two-three months. I am lucky enough to have not experienced mental illness. Regardless, I think there are important benefits from regularly talking with a professional therapist, especially in this context. For example, it helps me to understand my emotional vulnerabilities, and to limit the extent that I avoid or suppress uncomfortable feelings such as anxiety, self-doubt and frustration. Research shows that avoidance/repressive coping strategies in humanitarian workers – while helping us to carry on competently in high stress situations – in the mid to long term are significantly correlated with higher levels of depression, anxiety, PTSD and burnout.

• Not using alcohol (or drugs, or sex) as an unhealthy avoidance strategy, or one of the few ways you are able to relax – which it can easily become.

• Not relying on your workplace. At present, it is my opinion that much of the culture and policies of the humanitarian world for both international and national staff care remain shortsighted and behind the times – with the exception of physical security and physical health. So take responsibility for, have pride in and be prepared to advocate for your own mental health and that of your staff, accepting you may not always get a great deal of institutional or collegial support for this.

• Having external professional supervision. As a relative newbie to a context like present-day Afghanistan as well as to a senior management role in program implementation, having external supervision to check in on my professional/personal resilience and development (but not for therapeutic purposes) has been helpful. It’s common or even compulsory in many other ‘helping’, high stress fields. I do this every three months with someone who specialises in this area and has decades of humanitarian experience.

• Monitoring ‘people time’ according to your personality. When I’m energised and doing well, I’m generally a chatty, bubbly person who likes people. Though being fairly introverted, I require a decent amount of time alone in order to feel myself and enjoy being with people – especially those I don’t know well or in large groups. So in Afghanistan I make sure to take plenty of time out, especially when I have people-intensive tasks during the day. Of course, for more extroverted people, the opposite approach will likely be important for their wellbeing and energy levels.

• Taking extra steps to deal with traumatic events. My husband recently experienced intense personal trauma, and through him, to some extent I experienced it vicariously. Research links more symptoms of depression and PTSD in humanitarians with adult experiences of trauma, so it’s worth seeking extra support for both vicarious and direct trauma. This industry is thankfully getting better at providing appropriate support or treatment following direct experience of traumatic events/critical incidents. For example, organisations that have contracts with InterHealth or the Headington Institute, who have people trained to provide this kind of support to humanitarians.

• Treating yourself in small sensory ways that aid physical relaxation and enjoyment of the present moment. For me in Afghanistan this has included aromatic candles, good quality sheets, a photo book of landscapes from home, great smelling face wash, a few pieces of artwork, dark chocolate and music.

• Start thinking about (and preferably doing) these things before you go. I’m not sure that I would have had the time, energy and space to establish these efforts in the first month, and maintain them thereafter, without forethought and intentionality.

• Realising these are all habits. These things may sound like extra work on top of an already demanding work week, but they are essentially all habits, that once formed, don’t require a great deal of effort. We all form related habits anyway, so let them be thoughtful ones that take care of us and build our resilience. Taking good care of yourself is highly likely to result in being a more effective and enjoyable colleague, housemate, manager, friend and partner. It also helps mitigate the increasingly well-documented risk of higher levels – both in the short and long term – of anxiety, depression, burnout and PTSD in humanitarian workers.

There are – of course – days where I feel utterly exhausted, lonely, frustrated or convinced that I’m terrible at my job. That said, on the vast majority of days I truly feel very content here and grateful to be contributing to the work NRC does in Afghanistan, despite the numerous challenges and stressors.

Dr Naomi Johnstone, ICLA Specialist (Information, Counselling and Legal Assistance) for Afghanistan, Norwegian Refugee Council (6 months into posting). She has previously worked in conflict-affected Aceh (Indonesia), Sri Lanka, Bougainville (Papua New Guinea) and Jordan.